英汉对照骨科患者指南001：踝关节解剖

Ankle Anatomy

踝关节解剖

A Patient’s Guide to Ankle Anatomy

患者指南：踝关节解剖

Introduction

简介

The ankle joint acts like a hinge. But it’s much more than a simple hinge joint. The ankle is actually made up of several important structures. The unique design of the ankle makes it a very stable joint. This joint has to be stable in order to withstand 1.5 times your body weight when you walk and up to eight times your body weight when you run.

   踝关节就像一个铰链，但又不仅仅是一个简单的铰链关节。踝关节实际上是由几个重要的结构组成的。踝关节的独特结构特点使其成为一个非常稳定的关节。该关节在你步行时必须承受1.5倍体重的负荷，跑步时则需要承受8倍体重的负荷。

Normal ankle function is needed to walk with a smooth and nearly effortless gait. The muscles, tendons, and ligaments that support the ankle joint work together to propel the body. Conditions that disturb the normal way the ankle works can make it difficult to do your activities without pain or problems.

   为了能够以平稳而几乎毫不费力的步态行走，正常功能的踝关节则是必要条件。肌肉、肌腱及韧带有机结合并组成踝关节，从而起到推动身体前行的作用。一旦有任何影响踝关节正常运作的因素存在，那么很难避免在相关活动时出现踝关节疼痛或者其他问题。

This guide will help you understand

该指南有助于你理解

•  what parts make up the ankle

•  how the ankle works

• 踝关节的组成

• 踝关节的功能

Important Structures

重要结构

The important structures of the ankle can be divided into several categories. These include

   踝关节的重要结构分为若干个部分。包括：

• bones and joints

• ligaments and tendons

• muscles

• nerves

• blood vessels

• 骨与关节

• 韧带和肌腱

• 肌肉

• 神经

• 血管

The top of the  is referred to as the dorsal surface. The sole of the foot is the plantar surface.

   脚的顶部被称为足背面，脚底为足底面。

Bones and Joints

骨与关节

The ankle joint is formed by the connection of three bones. The ankle bone is called the talus. The top of the talus fits inside a socket that is formed by the lower end of the tibia(shinbone) and the fibula (the small bone of the lower leg). The bottom of the talus sits on the heel bone, called the calcaneus.

   踝关节是由三块骨头连接形成。“踝骨”称为距骨。距骨的顶部嵌入于由胫骨和腓骨的远端所形成的凹穴样结构。距骨底部则位于跟骨之上。

The talus works like a inside the socket to allow your foot to move up (dorsiflexion) and down (plantarflexion).

   距骨在凹穴内活动时，你的脚就在向上（背屈）或者向下（跖屈）运动了。

Woodworkers and craftsmen are familiar with the design of the ankle joint. They use a similar construction, called a mortise and tenon, to create stable structures. They routinely use it to make strong and sturdy items, such as furniture and buildings.

   木匠和工匠似乎很熟悉踝关节的构造。他们利用类似的结构，称为榫卯，用以创造稳定的结构。他们经常应用它来制作牢固而结实的物品，例如家具和建筑物。

Inside the joint, the bones are covered with a slick material called . Articular cartilage is the material that allows the bones to move smoothly against one another in the joints of the body.

   在关节内部，骨骼都被一种称为关节软骨的光滑组织覆盖着。由于关节软骨的存在，关节内相邻骨骼之间能够平滑地移动。

The cartilage lining is about one-quarter of an inch thick in most joints that carry body weight, such as the ankle, , or . It is soft enough to allow for shock absorption but tough enough to last a lifetime, as long as it is not injured.

   绝大多数承重关节的软骨约有四分之一英寸厚，如踝关节，髋关节，膝关节。由于它足够柔软，可以很好地起到缓冲震荡的作用，同时又足够坚韧，在不受损伤的前提下，可一生受用。

Ligaments and Tendons

韧带和肌腱

Ligaments are the soft tissues that attach bones to bones. Ligaments are very similar to tendons. The difference is that tendons attach muscles to bones. Both of these structures are made up of small fibers of a material called collagen. The collagen fibers are bundled together to form a rope-like structure. Ligaments and tendons come in many different sizes and like rope, are made up of many smaller fibers. Thickness of the ligament or tendon determines its strength.

   韧带是连接骨头与骨头的软组织。韧带与肌腱十分类似。所不同的是，肌腱连接肌肉与骨骼。这两种结构都是由一种称为胶原的小纤维构成的。许许多多的胶原纤维成束状结合在一起，形成了绳索状的结构。许多小纤维束构成了许多不同大小的绳索样的韧带和肌腱。韧带或肌腱的厚度决定其强度。

Ligaments on both sides of the ankle joint help hold the bones together. Three ligaments make up the lateral ligament complex on the side of the ankle farthest from the other ankle. (Lateral means further away from the center of the body.) These include the anterior talofibular ligament (ATFL), the calcaneofibular ligament(CFL), and the posterior talofibular ligament (PTFL). A thick ligament, called the deltoid ligament, supports the medial ankle (the side closest to your other ankle).

   踝关节两侧的韧带有助于维持骨骼之间的连接。踝关节外侧韧带复合体由三个韧带组成，该复合体位于该脚踝距离另一个脚踝最远的那一侧。（外侧意味着离身体的中心更远）。该复合体包括距腓前韧带（ATFL），跟腓韧带（CFL），和距腓后韧带（PTFL）。一条被称为三角韧带的厚韧带，则维持脚踝内侧面（最接近你另一个脚踝的那一侧）。

Ligaments also support the lower end of the leg where it forms a hinge for the ankle. This series of ligaments supports the ankle syndesmosis, the part of the ankle where the bottom end of the fibula meets the tibia. Three main ligaments support this area. The ligament crossing just above the front of the ankle and connecting the tibia to the fibula is called the anterior inferior tibiofibular ligament (AITFL). The posterior fibular ligaments attach across the back of the tibia and fibula. These ligaments include the posterior inferior tibiofibular ligament (PITFL) and the transverse ligament. The interosseous ligament lies between the tibia and fibula. (Interosseous means between bones.) The interosseus ligament is a long sheet of connective tissue that connects the entire length of the tibia and fibula, from the knee to the ankle.

  在下肢远端形成踝关节铰链结构时，韧带也起到了支持作用。有一系列韧带保护踝部的下胫腓联合，即踝关节中胫骨远端与腓骨远端相接触的那一部分。有三个主要的韧带维持这一部位。其中，走行于踝前上部，连接胫、腓骨的韧带，被称为下胫腓前韧带（AITFL）。腓骨后韧带附着于胫骨和腓骨的背面。这些韧带包括下胫腓后韧带（PITFL）和横韧带。骨间韧带位于胫骨和腓骨之间。从膝关节到踝关节，骨间韧带是连接胫骨和腓骨全长的一长片状的结缔组织。

The ligaments that surround the ankle joint help form part of the joint capsule. A joint capsule is a watertight sac that forms around all joints. It is made up of the ligaments around the joint and the soft tissues between the ligaments that fill in the gaps and form the sac.

   包绕踝关节的韧带参与组成了关节囊的一部分。关节囊是包绕整个关节的封闭式囊状结构。它是由关节周围韧带和用于填补韧带之间间隙的软组织组成的。

The ankle joint is also supported by nearby tendons. The large Achilles tendon is the most important tendon for walking, running, and jumping. It attaches the calf muscles to the calcaneus (heelbone) and allows us to raise up on our toes. The posterior tibial tendon attaches one of the smaller muscles of the calf to the underside of the foot. This tendon helps support the arch and allows us to turn the foot inward. The anterior tibial tendon allows us to raise the foot. Two tendons run behind the outer bump of the ankle (the lateral malleolus). These two tendons, called the peroeals, help turn the foot down and out.

   附近的肌腱同样也起到维持踝关节的作用。跟腱是人体在走、跑、跳等活动时最重要的肌腱。它连接小腿肌肉与跟骨，可以让我们做脚趾站立的动作。胫后肌腱附着在小腿肌肉群中较小的一块并连着脚底。该肌腱有助于支撑足弓，并且能够让我们做脚向内收的动作。胫前肌腱可以让我们做脚抬起来的动作。脚踝的外侧隆凸状结构（外踝）后面有两条肌腱走行。这两个肌腱，被称为腓骨肌腱，有助于我们做脚向下屈和向外翻的动作。

Muscles

肌肉

Most of the motion of the ankle is caused by the stronger muscles in the lower leg whose tendons pass by the ankle and connect in the foot. Contraction of the muscles in the leg is the main way that we move our ankle when we walk, run, and jump.

   小腿肌肉比较强壮，它的肌腱经过踝关节，并且连接在足部，基于此，踝关节的大多数动作都是由小腿肌肉引发的。当我们走、跑、跳的时候，腿部肌肉收缩是引起踝关节活动的主要途径。

The key ankle muscles have been discussed earlier in the section on ligaments and tendons. These muscles and their actions are also listed here.

   关键的踝部肌肉已经在前面的韧带与肌腱部分论述过了。这些肌肉及其作用也罗列如下。

· The peroneals (peroneus longus and peroneus brevis) on the outside edge of the ankle and foot bend the ankle down and out.

· 腓骨肌肉群（腓骨长肌和腓骨短肌）位于踝和脚的外侧，能使踝关节跖屈和外翻。

· The calf muscles (gastrocnemius and soleus) connect to the calcaneus by the Achilles tendon. When the calf muscles tighten, they bend the ankle down.

· 小腿肌肉群（腓肠肌和比目鱼肌）通过跟腱连接到跟骨。当小腿肌肉收缩，可以使踝关节跖屈。

· The posterior tibialis muscle supports the arch and helps turn the foot inward.

· 胫后肌支撑足弓，并能使脚做向内收的动作。

· The anterior tibialis pulls the ankle upward.

· 胫前肌能使踝关节做背伸的动作。

Nerves

神经

The nerve supply of the ankle is from nerves that pass by the ankle on their way into the foot. The tibial nerve runs behind the medial malleolus. Another nerve crosses in front of the ankle on its way to top of the foot. There is also a nerve that passes along the outer edge of the ankle.

  踝关节神经支配来自于行经踝关节到达足部的一些神经，这些神经分出分支进入踝关节。胫神经走行于内踝后方。另一个神经走行于踝前方到达足背。还有一条神经沿着踝的外侧缘通过。

The nerves on the front and outer edge of the ankle control the muscles in this area, and they give sensation to the top and outside edge of the foot.

   分布于踝前面和外侧缘的神经控制着这些区域的肌肉，同时它们传递感觉到足背和足外侧边缘。

Blood Vessels

血管

The ankle gets blood from nearby arteries that pass by the ankle on their way to the foot. The dorsalis pedis runs in front of the ankle to the top of the foot. (You can feel your pulse where this artery runs in the middle of the top of the foot.) Another large artery, called the posterior tibial artery, runs behind the medial malleolus. It sends smaller blood vessels to the inside edge of the ankle joint. Other less important arteries entering the foot from other directions also supply blood to the ankle.

   踝关节附近的动脉经过踝关节到达足的走行中分出分支进入踝关节。足背动脉走行于踝前方到足背。（你可以在足背中间感受到该动脉的搏动。）另一个大动脉，称为胫后动脉，走行于内踝后方。从它这里分出更小的血管进入踝关节的内侧。另外，进入足部的其他来源的并且相对次要的动脉也给踝关节供应血液。

Summary

总结

As you can see, the anatomy of the ankle is very complex. When everything works together, the ankle functions correctly. When one part becomes damaged, it can affect every other part of the ankle and foot, leading to problems.

   正如你所看到的，踝关节的解剖非常复杂。当所有的组成部分共同协作时，踝关节才能正常地运作。当一个部分受损时，它可能会影响踝关节和脚的其他部分，从而导致问题的出现。

(韩健勇  译         沈延东  校）

韩健勇，男，主治医师，毕业于第二军医大学。

沈延东医师简介

宁波市医疗中心李惠利医院骨科主任医师

中国医疗保健国际交流促进会骨科分会足踝外科学组全国委员

中华医学会骨科学分会足踝外科学组青年委员

宁波市医学会骨科学分会足踝外科学组组长成员

宁波市医学会医学鉴定专家库成员

宁波市康复医学会骨科分会委员

      注重于复杂型关节内外骨折、骨盆和复杂髋臼骨折的手术，尤其是老年性骨折、人工关节置换、复杂的足踝部骨折脱位，足踝韧带、肌腱及软骨损伤，踇趾外翻、扁平足、马蹄内翻足、高弓足、足踝先天性畸形的矫正，足踝部关节炎、肿瘤以及足跟疼痛症的治疗等。

专家门诊时间：周二上午（骨科）    周三下午（足踝外科）

患者指南，图文并茂，

分门别类，构思巧妙。

深入浅出，中英对照，

医患携手，共同探讨。

能力有限，时间仓促，

错误难免，诚惶诚恐。

恳请各位，留言指导，

以利再版，更加周到。